As an introduction, let me just say this: In this article, I detail that doctors and hospitals and pharmacies are going to bail out of Medicare and Medicaid – if they don’t just go out of business altogether. They aren’t bailing out on private insurers – the free market businesses that Obama and the Democrats have continuously demonized and demagogued – they’re bailing out on the very government health care systems that liberals want to erect in the place of the free market health care system that they are destroying. And as a matter of fact, the poorest and neediest are the ones who will likely suffer the most due to this terrible ObamaCare bill.

Congratulations, Democrats. Thanks to the passage of ObamaCare, you and all your useless slacker friends who love to parasitically leach off of society will have access to health care.

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility.

The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

Sorry to throw you out on your ass, old timer. But the government health care system sucks, and Zero is going to make it even suckier.

Physicians will not be bullied into bankruptcy. Our system needs reform, but what’s being hammered out in Washington is not the answer.

Two weeks ago the Mayo Clinic shocked the nation when it closed the doors of one of its Arizona clinics to patients on Medicare. Just this past June President Obama himself praised Mayo as a model of medical efficiency noting that Mayo gives “the highest quality care at costs well below the national norm.” If Mayo feels compelled to walk away from this government-run program, others will surely follow. The nation must understand why.

Doctors are leaving Medicare for two reasons: one obvious, the other more concealed.
The first is simple—the math:

2) On January 1, 2010 Washington made hidden cuts to Medicare by altering its billing codes.

3) Medicare will cut physician reimbursement by another 21% on March 1. The CBO said this cut must take place if the Senate healthcare bill was to “reduced the deficit.”

4) Even more, Congress pledged to cut Medicare by yet another $500 billion. Again, the CBO said this additional cut must take place if the Senate healthcare bill was to “reduced the deficit.”
Many physicians were operating at a loss even before this series of massive cuts. In 2008, Mayo Clinic posted an $840 million loss in caring for Medicare patients. No businesses can survive when patient care expenses exceed revenue.

The second is more ominous—Washington’s increasingly abusive posture toward physicians.

President Obama reflected this attitude last summer. On national television, he stated as fact a surgeon is paid between $30,000 and $50,000 for amputating a patient’s foot.

In reality, a surgeon is paid between $740 and $1,140 to perform this unfortunate, but often life-saving procedure. This reimbursement must cover a pre-operative evaluation the day of surgery, the surgery, and follow-up for 90 days after surgery—not to mention malpractice insurance, salaries for clinic nurses, and clinic overhead. It is frightening to think our president is so wildly misinformed even as he stands on the cusp of overhauling American health care. But it gets worse.

Given massive federal deficits, Washington now faces increasing pressure to cut Medicare spending. One way to do this is to intimidate physicians into under-billing. To do this Washington intends to spend tax payer dollars to ramp up physician audits using Recovery Audit Contractors (RAC audits) to randomly investigate private physician’s Medicare billing.

A physician group at my hospital recently experienced an AdvanceMed audit, an earlier version of the RAC. For a year Medicare auditors made their practice a living hell, making them question if it was worth caring for Medicare patients at all. [click to keep reading]

Do you remember that bit about the Mayo Clinic no longer accepting Medicare patients in Arizona? That’s a trend the rest of the country is going to follow. From the Wall Street Journal:

President Obama last year praised the Mayo Clinic as a “classic example” of how a health-care provider can offer “better outcomes” at lower cost. Then what should Americans think about the famous Minnesota medical center’s decision to take fewer Medicare patients?

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Mayo says it lost $840 million last year treating Medicare patients, the result of the program’s low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.

Walgreens will stop taking new Medicaid patients in Washington state as of April 16, saying it loses money filling their prescriptions.

Effective April 16, Walgreens drugstores across the state won’t take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

If ObamaCare passes, you may lose your family doctor. Oh, and good luck finding a new one.

That’s the stunning conclusion of a new study by the Medicus Firm, as reported by Recruiting Physicians Today, a newletter published by the publishers of the New England Journal of Medicine. Medicus, a national physician search firm, surveyed 1,195 practicing physicians about the health reform plans pending in Congress. The doctors, representing a wide range of specialties and career levels, were asked to assess the possible impact of ObamaCare on their careers, including “income, job satisfaction, and future career plans.”1

The bottom line of that investigation, titled Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care, is summed up by Medicus managing partner Steve Marsh: “What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer. The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.”2

Why? Put simply, doctors fear that ObamaCare would make the business and practice of medicine more trouble than it’s worth. The surveyed physicians foresee in their future under ObamaCare a decrease in income coupled with an increased work load, a toxic combination of new regulations and taxes plus millions of newly insured individuals swelling their patient rosters.

The doctors assessed the possible impact of several iterations of ObamaCare. For example, 72 percent felt their income would decrease under a health reform bill that included a public option, while 50 percent predicted a decrease in income under a health reform regime without a public option.

Not surprisingly, “an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform” as opposed to the massive, one-size fits all plans favored by the President and Congressional leaders.3An astonishing 46 percent of responding primary care physicians claim they would leave or try to leave medicine as a result of ObamaCare, gravely exacerbating the existing shortage of primary care doctors (according to the American Academy of Family Physicians, the number of U.S. medical school students choosing primary care has already dropped 52 percent since 1997).4

The Medicus results echo a similar Investors Business Daily poll of over 1,000 practicing physicians, 65 percent of whom expressed opposition to the President’s health reform plan, and 72 percent of whom doubted the administration’s claim that the government could significantly expand coverage and provide better care at lower cost. The IBD poll, conducted in September of 2009, also found a startling number of physicians, 45 percent, who would consider quitting if ObamaCare becomes law. The grim conclusion of the IBD survey: “Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted.”5

If ObamaCare would drive practicing doctors out of work, it would also devastate efforts to recruit new physicians. After all, how do you persuade talented young people to enter a business that promises high taxes, regulation, risk and stress – without commensurate compensation? For the average health care consumer, the result of this shrinking pool of physicians would be long waits and rationed care, to say nothing of overworked, unhappy doctors.

A CNN Money article details that children and the poorest and most vulnerable adults are going to increasingly suffer as doctors bail out of Medicaid.

There’s another inherent rub there. Democrats pitched ObamaCare as taking care of “47 million Americans” who can’t afford insurance. But the poor always had access to coverage under Medicaid. The only reason many of these people don’t use Medicaid is because the government program is such a total disaster, or they can’t find a doctor who will lose money treating them.

And that “47 million” clearly includes 17 million illegal immigrants. The Democrats’ incredibly cynical plan is to take health resources from you and from your children and grandchildren and give those resources to illegal immigrants so they can capture the Hispanic vote.

The bottom line about ObamaCare is that it is a government program, in which the government demonizes and destroys the private system of insurers and doctors and hospitals and pharmacists that make the system work, and offer in its place an utter disaster.

This ObamaCare boondoggle is going to be a holocaust. God only knows how many people – especially the poorest and most vulnerable – are going to die. It’s going to be legalized murder.

They say the road to hell is paved with good intentions. I don’t think the Democrats’ intentions are all that good, but I do know that this is a road – scratch that, a superhighway – to hell.

With Obamacare being forced down our throats, now is not the time to shrivel away. Now is the time to stand up and fight back harder then ever before. Will you join us on a campaign to DESTROY THE MOUTHPIECE OF OBAMA’S SOCIALIST AGENDA, THE MAINSTREAM MEDIA? WE ARE IN A FIGHT FOR THE FUTURE OF OUR COUNTRY, A FIGHT FOR OUR CHILDREN’S FUTURE. Join the fight here, http://sosssn.blogspot.com/

Michael,
Excellent article. I couldn’t agree with you more. I have been telling my friends and colleagues for months now that Obamacare will create a devastating environment to practice medicine in this country. What is going to happen to the thousands of physicians who still carry hundreds of thousands in student loan debt. How do individual physicians or small group practices stay in business? I never heard discussion about what doctors may do when this passes, but these numbers you indicate of physicians leaving the field is shocking. Also, fewer students entering medical school will mean less new doctors coming into the system. The trickle down effect will be enormous.

Dr. Woeller,
From the time I was a child I was taught to respect and trust my physicians (my brother and I had the same primary doctor – Dr. Lennertz – from when I was in pre-school until high school.

Frankly, our doctors and medical professionals deserve better. Doctors are highly trained professionals who should be well-compensated for their skills.

But the government could frankly give a rat’s butt. The more they take over health care, the more they will want to reduce costs. Costs and spending will soar as an incompetent bureaucracy takes over. All the resources will go into the wasteful bureaucracy. And so doctors and patient care will be crowded out.

This has already been going on. Medicare is TWICE as likely to deny treatment as the private insurance Obama has immorally demonized. TWICE!!! And doctors and hospitals are already literally LOSING money to treat Medicare/Medicaid patients. And the only thing that keeps them from bailing is their oath to take care of the sick.

What is sickest of all is what liberals want to do to my relationship with my doctor, to the previous high quality level of care I used to expect, and to the doctors who are now expected to lose money caring for patients.

I am so sad. I never thought I would see the day that I would question my college age son’s desire to be a doctor. However, as our family income continues to decline, (husband is a primary care doctor and I am an allied healthcare professional), we see the writing on the wall. Medical school will no longer be worth the long-term investment of time and money. We will be encouraging our son to use his talents otherwise.

Remember how the medical profession ran in prestigious families, and sons became doctors just as that son’s father became a doctor after his father before him?

It’s pretty sad, Barbara, that your husband is in a unique position to know just how bad ObamaCare will be to the field of medicine – and doesn’t want his own son to make a terrible career choice by becoming a DOCTOR.

I know that no one cares more about a son’s future than that son’s parents (including the son quite often!!!).

If your son has the talent to become a doctor, then you are right: he has the talent to do many other things, as well.

I am saying a prayer for what is clearly a difficult decision for your son’s future.

How about the position I now find myself and my wife in. We are both in our late 30’s and have been practicing a few years. We had 600k in loans at one point, now about 480k. It is all we can do to pay our rent, and try to save for our one child’s education. We will probably have no more as we are unsure we can afford it.

I am distraught over this bill, and yes, I have read the entire thing in the wee hours of my 24 hour call nights. I am doing everything I can to get out of medicine. THe problem now is that I need to make a certain wage just to cover our school loans. SO, after 13yrs of education and 100+ hour work weeks, I started an evening MBA program.

Not in a million years would I ever recommend the practice of medicine to anyone, and both my wife and myself are not in primary care.

Thank you Mr Obama, and to all others that voted for you….you will get what you asked for. Do you think I now give the best care I am capable of when all I can think about is how I got myself in this shi&&y mess?? THink about it the next time you see your doctor. I for one would like my doctor to be happy, but imagine you are talking to a doctor that in his/her mind hates her job for the BS bureaucracy.

Dr. Hatch,
What a sad story. I wish I could say, like Bill Clinton, “I feel your pain.” Only I’m not the liar he is.

I can’t even imagine what it must be like for yourself and your wife to see their entire career destroyed by demagoguery and political ideology. Your wife and you got out of medical school, and had every reason to believe that you were at the pinnacle of your lives. And then Obama came along and “saved” health care. The way Neville Chamberlain “saved” Britain as he attained “peace in our time.”

I understand what you’re saying in the last paragraph: you want to give your patients your best, but you are so worried about your own situation that you are having a harder and harder time existentially putting your patients first. The fact that you even worry about that means you’re likely a first rate doctor.

We’ve passed the health care destruction act, and like so many other political acts, it will likely take a number of years before the destruction REALLY starts hurting – and frankly even killing – people.

Whatever you do, I believe you’ll ultimately do well. I will put your name on my prayer list, and call upon the Lord to lead your family to opportunities.